Efficacy of emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones: a meta-analysis.

OBJECTIVE: To compare the clinical efficiency and safety of emergency extracorporeal shock wave lithotripsy (eESWL) and delayed extracorporeal shock wave lithotripsy (dESWL) in the treatment of ureteral stones. METHODS: Cochrane Library, PubMed, Google Scholar, and Web of Science were searched from January 1, 1992 to September 30, 2022, and all comparative studies involving eESWL and dESWL for ureteral calculi were included. Statistical analysis was performed using Review Manager 5.3 software. Funnel plot was used to evaluated publication bias. RESULTS: A total of 9 articles involving 976 patients diagnosed with ureteral stones were included. The results showed that the stone-free rate (SFR) after four weeks was significantly higher in the eESWL group than in the dESWL group [relative risk (RR) = 1.22, 95% confidence interval (CI): 1.13-1.32, P < 0.01]. In subgroup analysis of different stone locations, proximal ureteral calculi [RR = 1.25, 95% CI: 1.14-1.38, P < 0.01] and mid-to-distal ureteral calculi [RR = 1.18, 95% CI: 1.03-1.34, P < 0.05] all showed a higher SFR in the eESWL group. eESWL significantly shortened the stone-free time(SFT) [mean difference (MD) = -5.75, 95% CI: -9.33 to -2.17, P < 0.01]. In addition, eESWL significantly reduced auxiliary procedures [RR = 0.53, 95% CI: 0.40-0.70, P < 0.01]. No significant difference in complications was found between the two groups [RR = 0.90, 95% CI: 0.69-1.16, P > 0.05]. CONCLUSION: eESWL can significantly improve SFR, shorten SFT, and reduce auxiliary procedures.

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis.

BACKGROUND: To compare the postoperative continence and clinical outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) with non-RS RALP for patients with prostate cancer. METHODS: We searched PUBMED, EMBASE and the Cochrane Central Register from 1999 to 2019 for studies comparing RS-RALP to non-RS RALP for the treatment of prostate cancer. We used RevMan 5.2 to pool the data. RESULTS: A total of seven studies involving 1620 patients were included in our meta-analysis. No significant difference was found in positive surgical margins (PSM), bilateral nerve-sparing, postoperative hernia, complications, blood loss, or operative time. Postoperative continence was better with RS-RALP compared with non-RS RALP (OR = 1.02, OR: 2.86, 95% CI 1.94-4.20, p < 0.05). CONCLUSIONS: RS-RALP had a better recovery of postoperative continence than non-RS RALP. The perioperative outcomes were comparable for the two methods.

Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis.

BACKGROUND: To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. METHODS: We searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data. RESULTS: Four retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups. CONCLUSION: Retroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.

Preoperative Th1/Th2 and related cytokines: Prediction value in postoperative febrile UTI after ureteroscopy in patients with ureteral calculi.

BACKGROUND: The topic of whether preoperative Th1/Th2 cells and their related factors have a predictive value for postoperative febrile urinary tract infection (UTI) in patients with ureteral calculi has not been explored. OBJECTIVES: The objective of this study was to investigate the role of preoperative Th1/Th2 cells and related cytokines in the prediction of postoperative febrile UTI after ureteroscopy in patients with ureteral calculi. MATERIAL AND METHODS: One hundred sixty patients who underwent ureteroscopic pneumatic lithotripsy in the Affiliated Hospital of Hangzhou Normal University (China) were recruited and divided into febrile UTI group (n = 78) and non-UTI group (n = 82). Flow cytometry was used to detect the proportions of Th1 and Th2 cells (Th1% and Th2%). Detection of Th1/Th2 cell-related cytokines was conducted using enzyme-linked immunosorbent assay (ELISA). Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to measure the expression of T-bet and GATA3. RESULTS: Compared with patients in non-UTI group, those in febrile UTI group had significantly increased proportions of Th2 cells, levels of Th2 cytokines (interleukin (IL)-4, IL-10 and IL-5), and mRNA expression of Th2-associated transcription factor GATA3 (all p < 0.05). In addition, the Th1/Th2 ratio of febrile UTI group was significantly lower than that of non-UTI group (p < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the accuracy rate of Th2%, Th1/Th2 ratio, and IL-4, IL-10 and IL-5 levels for the diagnosis of postoperative febrile UTI in patients with ureteral calculi was 90.63%, 85.00%, 72.50%, 87.50%, and 91.88%, respectively, and their combined diagnostic sensitivity was 97.4% with specificity as high as 100%. CONCLUSIONS: Perioperative Th2 dominance was correlated with the risk of postoperative febrile UTI after ureterscopy in patients with ureteral calculi, which can provide clinical guidance for the development of individualized treatment.

Long Non-Coding RNA Cancer Susceptibility Candidate 2a (CASC2a) Is a Marker of Early Recurrence After Radical Cystectomy in Patients with Urothelial Carcinoma of the Bladder.

BACKGROUND The aim of this study was to investigate the expression of long non-coding RNAs (lncRNA) cancer susceptibility candidate 2a (CASC2a) in patients with urothelial carcinoma of the bladder (UCB) and its predictive value in the recurrence of UCB after radical cystectomy (RC). MATERIAL AND METHODS Tumor and paired adjacent normal tissues were obtained from 112 patients with UCB who underwent RC in our hospital from March 2010 to March 2012. The expression of CASC2a was evaluated by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and fluorescence in situ hybridization (FISH). RESULTS CASC2a was down-regulated in UCB tissues, and was highly negatively correlated with the pT, pN, tumor size, and lymphovascular invasion (LVI). The sensitivities of CASC2a for diagnosing UCB and its recurrence after RC were 89.30% and 81.55%, respectively, and the specificities were 71.43% and 58.21%, respectively. Patients with a high expression of CASC2a had a higher 5-year recurrence-free survival rate than those with low expression of CASC2a. Kaplan-Meier survival analysis demonstrated that the pT, pN, tumor grade, tumor size, concomitant carcinoma in situ (CIS), LVI, soft tissue surgical margin (STSM), and CASC2a expression were related to the recurrence in patients undergoing RC for UCB. Cox proportional hazard model analysis showed that CASC2 expression, pT4, lymph node metastasis, and CIS were independent risk factors. CONCLUSIONS CASC2a was down-regulated in patients with UCB, and was associated with the risk of recurrence among patients undergoing RC, indicating that lncRNAs could act as predictive biomarkers and potential therapeutic targets in bladder cancer, including CASC2a.

Expression of calmodulin-related genes in lead-exposed mice.

The toxic metal lead is a widespread environmental polutant that can adversely affect human health. However, the underlying mechanisms of lead-induced toxicity are still largely unknown. The mechanism of lead toxicity was presumed to involve cross reaction between Pb(2+) and Ca(2+) with calmodulin dependent systems. The aim of the present study was thus to identify differential expression of calmodulin-related genes in the spleen of lead-exposed mice. We performed microarray analysis to identify differentially expressed genes. RNAs from spleen tissue of lead exposed animals (n=6) and controls (n=6) were converted to labeled cRNA and hybridized to Illumina mouse WG-6_v2_Bead Chip. Expression profiles were analyzed using Illumina BeadStudio Application. Real-time RT-PCR was conducted to validate the microarray data. By microarray analysis 5 calmodulin-related genes (MAP2K6, CAMKK2, CXCR4, PHKA2, MYLK) were found to be differently expressed in lead exposed compared with control mice (p<0.05). The results of Real-time RT-PCR showed that MAP2K6 and CAMKK2 were up-regulated and CXCR4 was down-regulated in lead exposure, but there were no significant differences in PHKA2 and MYLK expression between the lead exposed and control group. These results show that lead exposure produced significant changes in expression of a variety of genes in the spleen and can affect calmodulin-related gene expression.

Lead-induced morphological changes and amyloid precursor protein accumulation in adult rat hippocampus.

Lead is an important environmental pollutant that exerts potent toxic effects on many organs. The toxic effects of lead are less well known for adult brain than for children. We investigated the morphological changes and amyloid precursor protein (APP) accumulation in the adult rat hippocampus following exposure to lead. Forty rats were divided into two groups of 20. One group was exposed to 580 parts per million (ppm) lead acetate and other group to an identical concentration of sodium acetate as a control group. After exposure to lead for 3 months, the hippocampus was examined by electron microscopy and APP levels in the hippocampus were detected using immunohistochemistry. Lead levels in the blood of rats exposed to lead were significantly higher than in the controls. The morphological changes in the hippocampus included mitochondrial degeneration, apoptosis and abnormal synapses in the rats exposed to lead. APP in hippocampus was increased significantly in the group exposed to lead compared to controls. We determined that lead exposure causes accumulation of APP and morphological changes in the adult rat hippocampus.

Effect of the duration of bladder overdistention on renal function and morphology in rats.

The aim of this study was to investigate the influence of the duration of bladder overdistention (DOBO) on kidney structure and function in rats. Bladder overdistention was induced in male Sprague-Dawley rats by an infusion of saline. Forty rats were divided into five groups: DOBO 1, 2, 4 or 8 h groups and the control. Renal function was evaluated using serum creatinine (SCr) and blood urea nitrogen (BUN). Apoptotic indices and morphologic changes of the kidney were detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) staining and transmission electron microscopy (TEM). Compared with the control, rats undergoing 2, 4 or 8 h of overdistention showed significant, time-dependent increases in SCr (12.375 vs. 23.125, 34.375 and 51.500 µmol/l, respectively), BUN (6.980 vs. 18.689, 25.184 and 32.079 mmol/l, respectively), renal size (1.041 vs. 1.472, 1.484 and 1.634 cm3, respectively) and renal pelvis separation (0.000 vs. 0.223, 0.320, 0.308 and 0.277 cm, respectively; P<0.01). In the rats, 2, 4 and 8 h of overdistention elicited time-dependent increases in the blood flow rate in the main renal artery (MRA; 44.827 vs. 49.082, 59.688 and 67.123 cm3/sec, control vs. DOBO 2, 4 and 8 h), the interlobar renal artery (IRA; 32.095 vs. 39.16 and 51.745 cm3/sec, control vs. DOBO 4 and 8 h) and the segmental renal artery (SRA; 21.171 vs. 24.355 and 25.358 cm3/sec, control vs. DOBO 4 and 8 h; P<0.01). TUNEL results showed that prolonged overdistention increased the apoptotic index of renal cells significantly (1.15, 1.77, 3.40, 5.34 and 13.91% for control and DOBO 1, 2, 4 and 8 h, respectively; P<0.01) and TEM indicated that prolonged overdistention resulted in ultrastructural injuries of increased severity. DOBO plays a significant role in the functional and structural impairment of the rat kidney. With increasing duration, the hemodynamic changes, cell apoptosis and ultrastructural injuries of the kidney are more evident, all of which may contribute to the increasingly serious impairment of renal function and morphology.

Effect of different durations of overdistention on rat bladder function and morphology

We investigated the contribution of the duration of overdistention (DOD) to rat bladder function and morphology and explored its possible molecular mechanisms. Bladder overdistention was induced in male Sprague-Dawley rats (200-250 g) by an infusion of saline. Forty rats were divided into 5 groups submitted to different DOD, i.e., 1, 2, 4, and 8 h, and control. Bladder function was evaluated by cystometry. Morphological changes were observed by light and transmission electron microscopy. Compared to control (44.567 ± 3.472 cmH2O), the maximum detrusor pressure of groups with 2-, 4- and 8-h DOD decreased significantly (means ± SEM): 32.774 ± 3.726, 31.321 ± 2.847, and 29.238 ± 3.724 cmH2O. With the increase of DOD, inflammatory infiltration and impairment of ultrastructure were more obvious in bladder tissue. Compared to control (1.90 ± 0.77), the apoptotic indexes of groups with 1-, 2-, 4-, and 8-h DOD increased significantly (6.47 ± 2.10, 10.66 ± 1.97, 13.91 ± 2.69, and 18.33 ± 3.28%). Compared to control (0.147 ± 0.031/0.234 ± 0.038 caspase 3/β-actin and Bax/Bcl-2 ratios), both caspase 3/β-actin and Bax/Bcl-2 ratios of 1-, 2-, 4-, and 8-h DOD increased significantly (0.292 ± 0.037/0.508 ± 0.174, 0.723 ± 0.173/1.745 ± 0.471, 1.104 ± 0.245/4.000 ± 1.048, and 1.345 ± 0.409/8.398 ± 3.332). DOD plays an important role in impairment of vesical function and structure. With DOD, pro-apoptotic factors increase and anti-apoptotic factors decrease, possibly contributing to the functional deterioration and morphological changes of the bladder.

Effect of different durations of overdistention on rat bladder function and morphology.

We investigated the contribution of the duration of overdistention (DOD) to rat bladder function and morphology and explored its possible molecular mechanisms. Bladder overdistention was induced in male Sprague-Dawley rats (200-250 g) by an infusion of saline. Forty rats were divided into 5 groups submitted to different DOD, i.e., 1, 2, 4, and 8 h, and control. Bladder function was evaluated by cystometry. Morphological changes were observed by light and transmission electron microscopy. Compared to control (44.567 ± 3.472 cmH2O), the maximum detrusor pressure of groups with 2-, 4- and 8-h DOD decreased significantly (means ± SEM): 32.774 ± 3.726, 31.321 ± 2.847, and 29.238 ± 3.724 cmH2O. With the increase of DOD, inflammatory infiltration and impairment of ultrastructure were more obvious in bladder tissue. Compared to control (1.90 ± 0.77), the apoptotic indexes of groups with 1-, 2-, 4-, and 8-h DOD increased significantly (6.47 ± 2.10, 10.66 ± 1.97, 13.91 ± 2.69, and 18.33 ± 3.28%). Compared to control (0.147 ± 0.031/0.234 ± 0.038 caspase 3/ß-actin and Bax/Bcl-2 ratios), both caspase 3/ß-actin and Bax/Bcl-2 ratios of 1-, 2-, 4-, and 8-h DOD increased significantly (0.292 ± 0.037/0.508 ± 0.174, 0.723 ± 0.173/1.745 ± 0.471, 1.104 ± 0.245/4.000 ± 1.048, and 1.345 ± 0.409/8.398 ± 3.332). DOD plays an important role in impairment of vesical function and structure. With DOD, pro-apoptotic factors increase and anti-apoptotic factors decrease, possibly contributing to the functional deterioration and morphological changes of the bladder.

Antitumor effects of human interferon-alpha 2b secreted by recombinant bacillus Calmette-Guérin vaccine on bladder cancer cells.

OBJECTIVE: Our objective was to construct a recombinant bacillus Calmette-Guérin vaccine (rBCG) that secretes human interferon-alpha 2b (IFNα-2b) and to study its immunogenicity and in vitro antitumor activity against human bladder cancer cell lines T24 and T5637. METHODS: The signal sequence BCG Ag85B and the gene IFNα-2b were amplified from the genome of BCG and human peripheral blood, respectively, by polymerase chain reaction (PCR). The two genes were cloned in Escherichia coli-BCG shuttle-vector pMV261 to obtain a new recombinant plasmid pMV261-Ag85B-IFNα-2b. BCG was transformed with the recombinant plasmid by electroporation and designated rBCG-IFNα-2b. Mononuclear cells were isolated from human peripheral blood (PBMCs) and stimulated with rBCG-IFNα-2b or wild type BCG for 3 d, and then cultured with human bladder cancer cell lines T24 and T5637. Their cytotoxicities were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: BCG was successfully transformed with the recombinant plasmid pMV261-Ag85B-IFNα-2b by electroporation and the recombinant BCG (rBCG-IFNα-2b) was capable of synthesizing and secreting cytokine IFNα-2b. PBMC proliferation was enhanced significantly by rBCG-IFNα-2b, and the cytotoxicity of PBMCs stimulated by rBCG-IFNα-2b to T24 and T5627 was significantly stronger in comparison to wild type BCG. CONCLUSIONS: A recombinant BCG, secreting human IFNα-2b (rBCG-IFNα-2b), was constructed successfully and was superior to control wild type BCG in inducing immune responses and enhancing cytotoxicity to human bladder cancer cell lines T24 and T5637. This suggests that rBCG-IFNα-2b could be a promising agent for bladder cancer patients in terms of possible reductions in both clinical dosage and side effects of BCG immunotherapy.

[Effects of Sema3A derived from tumor cells on functions of dendritic cells].

OBJECTIVE: To investigate the effects of tumor cell-derived Sema3A on the immunological functions of murine dendritic cells (DCs). METHODS: Lung adenocarcinoma A549 cells were transfected with small interference RNA, Si-Sema and Si-mut, and the interference efficiency was determined by real-time PCR and Western-blot. The concentrated supernatants from cultured tumor cells, Si-Sema and Si-mut-infected tumor cells were subjected to DCs respectively. The immunophenotypes of DCs were analyzed by flow cytometry, the production of IL-12P70 and the ability of DCs to stimulate DO11. 10 T cells secreting IFN-gamma and IL-2 were detected by enzyme linked immunosorbent assay (ELISA). RESULTS: Knockdown with Si-Sema3A significantly decreased the secretion of Sema3A by A549 cells in comparison with the Si-mut cells. DCs exposed to supernatants from Si-Sema cells showed elevated levels of MHC, CD40 and CD80, more production of IL-12P70, and enhanced capability of activating antigen-specific T cells, as evidenced by the remarkably increased levels of IFN-gamma and IL-2. CONCLUSION: A549 cells secrete Sema3A to inhibit the maturation and functions of DCs, which might be associated with the unidentified mechanism of immune evasion by tumor cells.

Prospective comparison of five mediators of the systemic response after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer.

OBJECTIVE: To evaluate whether high-intensity focused ultrasound (HIFU) is less invasive than targeted cryoablation of the prostate (TCAP), as experimental studies suggest that the acute-phase reaction is proportional to surgery-induced tissue damage. PATIENTS AND METHODS: Between May 2004 and December 2007, 127 consecutive patients undergoing HIFU (71) or TCAP (56) in our departments were assessed prospectively. Blood samples were collected 24 h before (T0), during surgery (T1), at the end of anaesthesia (T2), and at 12 (T3), 24 (T4) and 36 h after surgery (T5). The extent of the systemic response to surgery-induced tissue trauma was measured by assessing the levels of acute-phase markers tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-10, C-reactive protein (CRP) and serum amyloid A (SAA), at all sampling times in all patients. RESULTS: The median (interquartile range) age in the HIFU and TCAP groups was 70 (62-77) and 68 (59-75) years, respectively (P = 0.4). Baseline levels (T0) of TNF-alpha, IL-6, IL-10, CRP and SAA were comparable in both groups. The levels of all four markers increased during both procedures; the median values were higher for TCAP at T2 (P = 0.02, 0.001, <0.001 and 0.06), T3 (P < 0.001, 0.009, 0.003 and 0.001), T4 (P = 0.007, <0.001, 0.005 and <0.001) and T5 (P < 0.001, 0.004, <0.001 and 0.02), respectively. IL-6 was also higher for TCAP at T1 (P = 0.03). IL-10 did not change at the different sampling times. CONCLUSION: The tissue trauma and associated invasiveness of HIFU is less than that of TCAP, based on the variables objectively measured in this study.

[Construction of recombinant bacillus Calmette-Guérin vaccine secreting human interferon-alpha 2b].

OBJECTIVE: To construct a recombinant bacillus Calmette-Guérin vaccine (rBCG) secreting human interferon-alpha 2b (IFN alpha-2b). METHODS: BCG Ag85B signal sequence and IFN alpha-2b gene were amplified from the genome of BCG and of human peripheral blood by polymerase chain reaction (PCR), respectively. IFN alpha-2b gene was cloned in E. coli-BCG shuttle-vector pMV261 to get pMV261-IFN alpha-2b. A new recombinant plasmid pMV261-IFN alpha-2b was constructed by inserting BCG Ag85B signal sequence into pMV261-Ag85B-IFN alpha-2b. Then, BCG was transformed with this recombinant plasmid by electroporation, and designated as rBCG-IFN alpha-2b. The DNA and protein expressions of IFN alpha-2b gene in rBCG were determined by PCR and Western blot respectively. Also the quantity of IFN alpha-2b protein secreted by rBCG in culture supernatants was determined by enzyme linked immunosorbent assay (ELISA). RESULTS: By partial nucleotide sequencing, the DNA sequences of human IFN alpha-2b and BCG Ag85B were consistent with that in the Gene Bank, and were correctly inserted into the shuttle expression vector pMV261 to construct recombinant plasmid pMV261-Ag85B-IFN alpha-2b. BCG was successfully transformed with this recombinant plasmid by electroporation and the recombinant BCG (rBCG-IFN alpha-2b) was capable of synthesizing and secreting cytokine IFN alpha-2b. The concentration of IFN alpha-2b in culture supernatants was quantified by ELISA and calculated to be approximately 301.45 pg/ml. CONCLUSIONS: Recombinant BCG secreting human IFN alpha-2b (rBCG-IFN alpha-2b) was constructed successfully and the specific IFN alpha-2b protein can be expressed highly and steadily by rBCG vaccine.

Expression of telomeric repeat binding factor 1 protein in nonsmall cell lung cancer with human telomerase reverse transcriptase positive.

Telomeric repeat binding factor 1 plays pivotal roles in telomere protection and maintenance in mammalian cells. In this article, the expression of telomeric repeat binding factor 1 protein in nonsmall cell lung cancer with human telomerase reverse transcriptase positive is investigated, and the relationship between the telomeric repeat binding factor 1 and clinic factors is analyzed. The expressions of human telomerase reverse transcriptase were detected by immunohistochemistry. The levels of telomeric repeat binding factor 1 protein were measured by Western blot. In all, 72% (36/50) patients showed human telomerase reverse transcriptase positive. Telomeric repeat binding factor 1 expression of cancer tissues and paired noncancerous tissues in 30 cases of human telomerase reverse transcriptase positive was 0.552 +/- 0.329 and 0.654 +/- 0.476, respectively (P < .05). No significant difference in telomeric repeat binding factor 1 protein expression was observed among sex, clinical stages, pathological subtypes, and lymph node metastasis. The results indicated that down-regulation of telomeric repeat binding factor 1 expression appeared in lung cancer tissue, and no correlation was found between telomeric repeat binding factor 1 expression and clinicopathologic factors.

[Predictive factors for conversion of transurethral resection of the prostate to open prostatectomy].

OBJECTIVE: To evaluate the factors for the conversion of transurethral resection of the prostate (TURP) to open prostatectomy and to provide clinical evidence for surgical options. METHODS: From January 1997 to March 2005, we performed 1 086 TURP and made retrospective analyses of 11 risk factors concerning the demographics, clinical history, laboratory data, ultrasound results, and intraoperative complications of the patients. In addition, multivariate logistic regression was used to determine those variables predicting the conversion of TURP. RESULTS: Thirty-nine (3.59%) of the TURP cases required conversion, mostly because of uncontrollable hemorrhage (71.79%). Multivariate analyses showed that a prostate volume > 85.2 ml (OR = 2.568, P < 0.01), intraoperative slit of capsula prostatic (OR = 1.916, P < 0.01) and a second midstream bladder specimen (VB2) white blood cell count of the urine > 13.5/HP (OR = 1.486, P < 0.01) predicted the conversion to open prostatectomy. CONCLUSION: Benign prostatic hyperplasia (BPH) patients with a huge prostate and those with intraoperative slit of capsula prostatic undergoing TURP are more likely to be converted. And uncontrollable hemorrhage, huge prostate and poor endoscopic vision are the major reasons for the conversion.

Preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesion of different types.

AIM: To comparatively study the preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesions induced by four different factors in rats. METHODS: Chitosan was chemically modified by gelatinization, and made into films of 60 microm in thickness, and sterilized. Two hundred Sprague-Dawley rats were randomly divided into five groups, Sham-operation group (group A), wound-induced adhesion group (group B), purified talc-induced adhesion group (group C), vascular ligation-induced adhesion group (group D), and infection-induced adhesion group (group E), respectively. In each group, the rats were treated with different adhesion-inducing methods at the cecum of vermiform processes and then were divided into control and experimental subgroups. Serous membrane surface of vermiform processes were covered with the films in the experimental subgroups, and no films were used in the control subgroups. After 2 and 4 wk of treatments, the abdominal cavities were reopened and the adhesive severity was graded blindly according to Bhatia's method. The cecum of vermiform processes were resected for hydroxyproline (OHP) measurement and pathological examination. RESULTS: Adhesion severity and OHP level: After 2 and 4 wk of the treatments, in the experimental subgroups, the adhesions were significantly lighter and the OHP levels were significantly lower than those of the control subgroups in group B (2 wk: 0.199 +/- 0.026 vs 0.285 +/- 0.041 microg/mg pr, P < 0.001; 4 wk: 0.183 +/- 0.034 vs 0.276 +/- 0.03 microg/mg pr, P < 0.001), D (2 wk: 0.216 +/- 0.036 vs 0.274 +/- 0.040 microg/mg pr, P = 0.004; 4 wk: 0.211 +/- 0.044 vs 0.281 +/- 0.047 microg/mg pr, P = 0.003) and E (2 wk: 0.259 +/- 0.039 vs 0.371 +/- 0.040 microg/mg pr, P < 0.001; 4 wk: 0.242 +/- 0.045 vs 0.355 +/- 0.029 microg/mg pr, P < 0.001), but there were no significant differences in groups A (2 wk: 0.141 +/- 0.028 vs 0.137 +/- 0.026 microg/mg pr, P = 0.737; 4 wk: 0.132 +/- 0.031 vs 0.150 +/- 0.035 microg/mg pr, P = 0.225) and C (2 wk: 0.395 +/- 0.044 vs 0.378 +/- 0.043 microg/mg pr, P = 0.387; 4 wk: 0.370 +/- 0.032 vs 0.367 +/- 0.041 microg/mg pr, P = 0.853); Pathological changes: In group B, the main pathological changes were fibroplasias in the treated serous membrane surface and in group D, the fibroplasia was shown in the whole layer of the vermiform processes. In group E, the main pathological changes were acute and chronic suppurative inflammatory reactions. These changes were lighter in the experimental subgroups than those in the control subgroups in the three groups. In group C, the main changes were foreign body giant cell and granuloma reactions and fibroplasias in different degrees, with no apparent differences between the experimental and control subgroups. CONCLUSION: The gelatinizedly-modified chitosan film is effective on preventing peritoneal adhesions induced by wound, ischemia and infection, but the effect is not apparent in foreign body-induced adhesion.

Preventive effects of chitosan on peritoneal adhesion in rats.

AIM: To study the effects of chitosan gel and blending chiston/gelatin film on preventing peritoneal adhesion in rats. METHODS: SD rats were randomly divided into 2 groups, group A treated with chitosan gel and group B with blending chiston/gelatin film. In group A, rats were randomly subdivided into 3 subgroups as groups A1, A2 and A3, and different methods were used to induce peritoneal adhesions at the dead end of vermiform process in each group as follows: Group A1 with trauma, A2 with talc powder and A3 with ligation of blood vessel. In each subgroup, rats were redivided into control group and experimental group whose treated vermiform processes were respectively coated with chitosan gel and normal saline immediately after the adhesion-induced treatments. In group B, all the rats received traumatic adhesion-induced treatments and then were randomly divided into 4 groups (groups B1, B2, B3, B4). Group B1 served as control group and were coated with normal saline in the vermiform processes immediately after the treatments, and groups B2, B3 and B4 with 100% chitosan film, chitosan film containing 10% gelatin and chiston film containing 50% gelatin, respectively. At 2 and 4 wk after the above treatments, half of the rats in each terminal group were belly opened, and the peritoneal adhesive situation was graded and histopathological changes were examined. RESULTS: (1) In group A, regarding peritoneal adhesion situation: At both 2 and 4 wk after the treatments, for groups A1 and A3, the adhesive grades of experimental groups were significantly lower than those of the control group (2 wk: H = 4.305, P < 0.05 for A1, H = 6.743, P < 0.01 for A3; 4 wk: H = 4.459, P < 0.05 for A1, H = 4.493, P < 0.05 for A3). However, of group A2, there was no significant difference between the experimental and control groups (2 wk: H = 0.147, P > 0.05; 4 wk: H = 1.240, P > 0.05). Regarding pathological changes: In groups A1 and A3, the main pathological change was fibroplasia. In group A2, the main changes were massive foreign-body giant cell reaction and granuloma formation with fibroplasia of different degrees. (2) In group B, regarding degradation of film: With increase of the blended gelatin concentration, degrading speed of the film accelerated significantly. Regarding peritoneal adhesion situation: At both 2 and 4 wk after the treatments, the adhesive grades of B1 were the lowest among the four subgroups of B (2 wk: H = 29.679, P < 0.05; 4 wk: H = 18.791, P < 0.05). At 2 wk after the treatments, the grades of group B2 were significantly lower than that of groups B3 and B4 (H = 4.025, P < 0.05 for B2 vs B3; H = 4.361, P < 0.05 for B2 vs B4). At 4 wk, there were no significant differences of the grades between groups B2, B3 and B4. Regarding pathological changes: Inflammatory cell infiltration and fibroplastic proliferation were observed in the local treated serous membranes, which was the mildest in group B1. Slight foreign-body giant cell reactions were also found in groups B2, B3, and B4. CONCLUSION: (1) Chitosan gel has preventive effect on traumatic or ischemic peritoneal adhesion, but no obvious effect on foreign body-induced peritoneal adhesion. (2) Chitosan film may exacerbate the peritoneal adhesion. Blending with gelatin to chitosan film can accelerate the degradation of the film, but can simultaneously facilitate the formation of peritoneal adhesion.

[Characteristics of genesis and development of peritoneal adhesion by different causes: experiment with rats].

OBJECTIVE: To investigate the characteristics of genesis and development of peritoneal adhesion by different causes. METHODS: 236 rats underwent laparotomy with their vermiform processes lifted up and were randomly divided into 5 groups: Group A (control group), with the vermiform process exposed to air for 5 min, Group B, with the vermiform process smeared with talcum powder; Group C, with the vermiform process scraped by scalpel; Group D, with the tip of vermiform process stabbed by needle so as to squeeze the contents of intestine to cause infection; and Group E, with the artery of vermiform process ligated. Then the abdominal incision was sutured. 1, 2, 4, and 6 weeks after the treatment 11-12 rats from each group were randomly to undergo laparotomy. The degree of adhesion was graded blindly by Bhatia's method. The vermiform process was resected to undergo pathological examination and examination of the level of organ hydroxyproline (OHP) was detected. RESULTS: (1) At different time points the adhesive grades of Groups B-E were all significantly higher than that of Group A (all P < 0.05) and the adhesive grades of Groups B and D were both significantly higher than those of Groups C and E (both P < 0.05). There were no significant differences in the adhesive degree 1, 2, and 4 weeks after the treatment between Groups C and E, however, the adhesive degree of Group E was significantly lower than that of Group C (P < 0.05). (2) There were not significant differences in the OHP levels at any time points in Group A (all P > 0.05). There were not significant differences in the OHP levels 1, 2, and 4 weeks after the treatment (all P > 0.05), and the levels 8 weeks after the treatment were all significantly lower than those 1, 2, and 4 weeks after the treatment (all P < 0.05) in Groups B, D, and E. In Group C the OHP level 2 weeks after the treatment was 0.275 +/- 0.031 microg/mg protein, significantly lower than that 1 week after (0.221 +/- 0.036 microg/mg protein, P < 0.05), and the OHP level 8 weeks after the treatment was 0.254 +/- 0.039 microg/mg protein, significantly lower than those 1, 2, and 4 weeks after (all P < 0.05). The OH levels 1, 2, and 4 weeks after the treatment of the 4 experimental groups were all significantly higher than that of the control group (all P < 0.05). 8 weeks after the treatment the level of OHP of Groups B was significantly higher than that of Group A (P < 0.05), however, the OHP levels of Group C, D, and E had all decreased to almost similar to that of Group A (all P > 0.05). (3) The adhesive degrees of Groups C and E were significantly positively correlated with the OHP level (both P < 0.05), however, the adhesive degrees of Groups B and D were not significantly correlated with the OHP level (both P > 0.05). The adhesive degrees 1, 2, and 4 weeks after the treatment of the 5 groups were all significantly positively correlated with the OHP levels (all P < 0.05, however, the adhesive degrees 8 weeks after the treatment of the 5 groups were all not significantly correlated with the OHP levels (all P > 0.05). (4) The main pathological changes of Group B were foreign body granuloma reaction and fibroplasia in Group B and unspecific inflammatory reaction and fibroplasia in Groups C, D, and E. CONCLUSION: Abdominal adhesions resulting from different causes show different characteristics. The abdominal adhesion caused by foreign bodies and that caused by infection are relatively severe and more difficult to recover than those caused by injury and ischemia. It is more reliable to use OHP level as a marker of abdominal adhesion in the early stage.